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Home My WebLink AboutWire Permit - Permits #13266-1 - 65 CASTLEMERE PLACE 4/13/2016 00101 \� \\ \, \. � Date.. �.:. .�.:.� ..... �,�: Iii \\\ \ r7 O01 1, TOWN: OF NORTH ANDOVER IN IN N f sMAI This certifies that __......_.._... .. .._ ................... ngggims L hase permission to perform t;._... ............ :. .. ..... ...............................o wiring in -�he hilding of ...a ....9 ......................................... �� _ ... .......:......... H. .... \ . .at ......_.........� North Andover, ass. 111\ INSPECTOR Fee ... Lic. Now ................_u. ........................................... ........ gg �. _..... �� 11 gi \\ � �crxrcaz. WINNEM CheckN Al Ni Mile 3/30/2016 View File p Official Use Only Permit No. aaw . . .t ct t» aa^ iad Occupancy and Fee Checked BOAR ) OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION),.., ____ _Date: March 30, 2016 City or Town of: North Andover, MA_ To the Inspector of Wires: By this""application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 65 Castlemere Pl Owner or Tenant Rosemary Loran e�r_ Telephone No. (978)984-5442 Owner's Address 65 Castlemere PI Is this permit in conjunctiio with a building permit? Yes ...,..No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts .w.. Overhead Undgrd No.of Meters New Service ......v_,. Amps / Volts , w Overhead Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of a low-voltage wireless burglar alarm system Completion of the fallowing table may be waived by the Inspector of Wires. o.of Recessed Luminaires o.of Ceil:Susp.(Paddle)Fans No of Total ansformers KVA o.of Luminaire Outlets No.of Hot Tubs Generators-----."W _w„" " Mm" KVAa nNM- o.of Luminaires Swimming Pool Above In- o.of Emergency Lighting g nd. grnd. Battery Units o.of Receptacle Outlets No.of Oil Burners FIRE ALARMS o.of Zones o.of Switches o.of Gas Burners o. Detection and Initiatin Devices o.of Ranges No.of Air Cond. Tons o.of Alerting Devices o.of Waste Disposers eat Pump umber ons o.of Self-Contained P Totals: Detection/Alerting Devices o.of Dishwashers pace/Area HeatingKW Local Connection Other Connection o.of Dryers Heating Appliances_ KW Security Systems:* y g pp No.of Devices or Equivalent No.of Water KW o.of No.of Data Wiring: Heaters Silms Ballasts No.of Devices or Equivalent o.H dromassa a Bathtubs o.of Motors Total III elecommunications Wiring: y g _.._. No.of Devices or Equivalent THER: Attach additional detail if desired,or as required by the Inspector of limes. Estimated Value of Electrical Work: $850.00 (When required by municipal policy.) Work to Start: March 30,2016 Inspections to be requested in accordance with MEC Rule 10,and upon completion. *INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND - OTHER (Specify:) I certify,under the pains and penalties ofperjury,that the information on t 's application is true and complete. FIRM NAME:Defender 5ecurity Company CoMpany LIC.NO.:C 1355 `? t. LIC.NO.:D 434 (f applicable, "exempt" `�^' I�° Signature Licensee: t� I a licable, enter exem t"in the license number line),-„ I Bus.Tel.No.:800-689-9554 Address: 3750 Priority Way S Drive Suite 200 hidiangpolis IN 46240 Alt.Tel.No.:866-502-3559 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SSCO-001258 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) owner owner's agent. Owner/Agent Telephone PERMIT FEE: $ https://www2.cifizenserve.com/AdminlPermit roll 1 1 1/2 https://www2.cifizenserve.com/AdmirilPermit ( °°) :4"A t, The Commonwealth of Massachusetts --- _�- .Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ? � www.mass.gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricions/Plumbers .Applicant Information Please Print Legibly Name(Business/Organization/Individual): Defenders Inc. dba Protect Your Home Address: 3750 Priority Way S Drive Suite 200 City/State/zip: Indianapolis, IN 46240 Phone#: 317-810-47.20 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. 0 I am a general contractor and 1 employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.L] 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. n Demolition 'k d h employees and workers'working for me in any capacity. 9. ❑Building addition [No workers'comp.insurance comp. insurance.1 required.] 5. We are a corporation and its 10.W Electrical repairs or additions 3.I1 I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.n Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: M J Insurance Policy#or Self iris.Lie.#: TCJ U B 1116 LO3015_.._ Expiration.Date: 07/01/2016 Job Site Address: City/State/Zip: _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: C, 5 5` Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector &.Other Contact Person: Phone#: vA O i O$ d A .Tf A �3T I CONTROL # NEI %` BOARD OF � IMPORTANT ELECTRICIANS ISSUES THE FOLLOWING LICENSE A If your license is lost,damaged or destroyed;is inaccurate,or A REG I STERED SYSTEM CONTRACTOR needs to be corrected,visit our web site at mass.gov/dpl for in tr..irtions to ensure the proper mailing of your Renewal Application and any other correspondence. DEFENDER SECURITY CO / PROTECT Y 4; VJ This license is subject to Massachusetts General Laws and STEPHEN C EHRL I CH regulations. four license is a privilege,and cannot be lent or w assigned to any person or entity under penalty of law, 3750 PRIORITY WAY SOUTH Keep This STE 200 ~ n°o license on your person or posted as required by lave andlor regulations. BIANAPOLI .E; IN 46240-3815 1355 C 07/31/16 38220 COM O 'EALTI-1 O!' A ACHU TTS CONTROL# rr BOARD OF IMPORTANT ELECTRICIANS ISSUES THE FOLLOWING LICENSE ' if your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpl for A REGISTERED SYSTEM TECHN I C I A x I' instructions to ensure the proper mailing of your Renewal Application and any other correspondence. STEPHEN C EHRL I CN This license is subject to Massachusetts General Laws and u regulations.Your license is a privilege,and cannot be lent or z assigned to any person or entity under penalty of law.Keep this 369 CENTRAL STREET license on your person or posted as required by lard and/or UNIT 9 regulations. 70XBOROUGH MA 02035-2637 434 D 07/31/16 4556C, Employer: DEFENDER SECURITY COMPANY SSGO-001258 STEPHEN C EHRLICH 3750 PRIORITY WV S DR 9200 INDIANAPOLIS IN 46240 For DPS Lirensinginformation visit: www.Mass.GovjDPS 12/03/2016 NOTICE OF COMPLETION OF ELECTRICAL WORK Pursuant to M.G.L. c. 143, § 3L, Stephen Ehrlich hereby provides written notice to the inspector of wires that the electrical work outlined in the preceding permit application has been completed.